Yang Seokhun, Koo Bon-Kwon
Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University of College Medicine, Seoul, South Korea.
J Soc Cardiovasc Angiogr Interv. 2024 Mar 26;3(3Part B):101304. doi: 10.1016/j.jscai.2024.101304. eCollection 2024 Mar.
Identifying functional significance using physiological indexes is a standard approach in decision-making for treatment strategies in patients with coronary artery disease. Recently, coronary computed tomography angiography-based physiological assessments, such as computed tomography perfusion and fractional flow reserve derived from coronary computed tomography angiography (FFR-CT), have emerged. These methods have provided incremental diagnostic values for ischemia-causing lesions over anatomical stenosis defined solely by coronary computed tomography angiography. Clinical data have demonstrated their prognostic value in the prediction of adverse cardiovascular events. Several randomized controlled studies have shown that clinical use of FFR-CT can reduce unnecessary invasive procedures compared to usual care. Recent studies have also expanded the role of FFR-CT in defining target lesions for revascularization by acquiring noninvasive lesion-specific hemodynamic indexes like ΔFFR-CT. This review encompasses the current evidence of the diagnostic and prognostic performance of computed tomography-based physiological assessment in defining ischemia-causing lesions and adverse cardiac events, its clinical impact on treatment decision-making, and implications for revascularization.
利用生理指标确定功能意义是冠心病患者治疗策略决策中的标准方法。最近，基于冠状动脉计算机断层扫描血管造影的生理评估，如计算机断层扫描灌注和源自冠状动脉计算机断层扫描血管造影的血流储备分数（FFR-CT）已出现。这些方法为仅由冠状动脉计算机断层扫描血管造影定义的解剖狭窄以外的缺血性病变提供了额外的诊断价值。临床数据已证明它们在预测不良心血管事件方面的预后价值。几项随机对照研究表明，与常规治疗相比，FFR-CT的临床应用可减少不必要的侵入性操作。最近的研究还通过获取诸如ΔFFR-CT等非侵入性病变特异性血流动力学指标，扩大了FFR-CT在定义血运重建目标病变方面的作用。本综述涵盖了基于计算机断层扫描的生理评估在定义缺血性病变和不良心脏事件方面的诊断和预后性能的当前证据、其对治疗决策的临床影响以及对血运重建的意义。
